Oncology & Hematology Coding Alert

Question: What's the difference between 19296-+19297 and 19298?

North Carolina Subscriber

Answer: The first two codes describe catheter placement for the newer technique of accelerated partial breast irradiation (APBI), such as the MammoSite system:

• 19296 " Placement of radiotherapy afterloading expandable catheter (single or multichannel) into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; on date separate from partial mastectomy
• +19297 " ... concurrent with partial mastectomy (list separately in addition to code for primary procedure).

APBI targets part of the breast after a lumpectomy. Treatment takes place over a five- to six-day period instead of the weeks that older techniques require.

What happens: The physician creates a tunnel or cubbyhole and inflates the expandable catheter so that it can't be removed. Later the patient returns for radiation, often for five treatments, twice a day, with six hours in-between.

Codes 19296 and +19297 describe identical procedures except for one difference. You should report +19297 when the physician performs the catheter placement on the day of the partial mastectomy. Note that +19297 is an add-on code, which CPT instructs you to report together with surgical codes 19301-19302 (Mastectomy, partial ...). On the other hand, you should report 19296 when the catheter placement happens at a later date. This code requires no primary procedure code to accompany it because it is not an add- on code.

The final code, 19298 (Placement of radiotherapy afterloading brachytherapy catheters [multiple tube and button type] into the breast for interstitial radioelement application following [at the time of or subsequent to] partial mastectomy, includes imaging guidance), describes when the physician inserts the radiotherapy afterloading brachytherapy catheters of the older multiple tube-and-button type.

Definition: The tube-and-button type is similar to little seeds sewn into a strand of wire with a little button so they don't fall off. These are then threaded through the skin where the physician performed the biopsy.